Distinguishing ADHD from OCD Critical to Treatment Success

Although different neuropsychological disorders may present similar symptoms, an accurate diagnosis is essential as clinical interventions may be dramatically different for each condition.

Improper treatment can exacerbate symptoms and can lead to harmful and dangerous outcomes.

Two relatively common disorders, obsessive compulsive disorder (OCD) and attention deficit/hyperactivity disorder (ADHD), fit this pattern as they often include symptoms of impaired attention, memory, or behavioral control.

In a new study, clinical psychologist Dr. Reuven Dar of Tel Aviv University’s School of Psychological Sciences argues that these two neuropsychological disorders have very different roots — and there are enormous consequences if they are mistaken for each other.

Dar and fellow researcher Amitai Abramovitch, Ph.D., have determined that despite appearances, OCD and ACHD are far more different than alike.

While groups of both OCD and ADHD patients were found to have difficulty controlling their abnormal impulses in a laboratory setting, only the ADHD group had significant problems with these impulses in the real world. Dar believes this proves that while OCD and ADHD may appear similar on a behavioral level, the mechanism behind the two disorders differs greatly.

That is, people with ADHD are impulsive risk-takers, rarely reflecting on the consequences of their actions. In contrast, people with OCD are all too concerned with consequences, causing hesitancy, difficulty in decision-making, and the tendency to over-control and over-plan.

Researchers believe their findings, published in the Journal of Neuropsychology, draw a clear distinction between OCD and ADHD and provide more accurate guidelines for correct diagnosis.

Ritalin, a psychostimulant commonly prescribed to ADHD patients, can actually exacerbate OCD behaviors, for example. Prescribed to an OCD patient, it will only worsen symptoms.

Researchers were able to determine the relationship between OCD and ADHD by studying three groups of subjects: 30 diagnosed with OCD, 30 diagnosed with ADHD, and 30 with no psychiatric diagnosis.

All subjects were male with a mean age of 30. Comprehensive neuropsychological tests and questionnaires were used to study cognitive functions that control memory, attention, and problem-solving, as well as those that inhibit the arbitrary impulses that OCD and ADHD patients seem to have difficulty controlling.

As predicted, both the OCD and ADHD groups performed less well than a comparison group in terms of memory, reaction time, attention and other cognitive tests.

Both groups were also found to have abnormalities in their ability to inhibit or control impulses, but in very different ways. In real-world situations, the ADHD group had far more difficulty controlling their impulses, while the OCD group was better able to control these impulses than even the control group.

When people with OCD describe themselves as being impulsive, this is a subjective description and can mean that they haven’t planned to the usual high degree, said Dar.

It is understandable why OCD symptoms can be mistaken for ADHD, Dar said. For example, a student in a classroom could be inattentive and restless, and assumed to have ADHD.

In reality, the student could be distracted by obsessive thoughts or acting out compulsive behaviors that look like fidgeting.

“It’s more likely that a young student will be diagnosed with ADHD instead of OCD because teachers see so many people with attention problems and not many with OCD. If you don’t look carefully enough, you could make a mistake,” said Dar.

Currently, 5.2 million children in the U.S. between the ages of 3 and 17 are diagnosed with ADHD, according to the Centers for Disease Control and Prevention, making it one of the most commonly diagnosed neuro-developmental disorders in children. By comparison, less than 10,000 children and adolescents are diagnosed with OCD.

Experts believe the correct diagnosis is crucial for successful outcomes as the diagnosis affects the choice of medication and psychological and behavioral treatment. Moreover, an accurate diagnosis significantly influences the manner in which families and teachers interact with the child and young adult.

Last reviewed: By John M. Grohol, Psy.D. on 19 Dec 2012 Published on PsychCentral.com. All rights reserved.

About Rick Nauert PhD

Dr. Rick Nauert has over 25 years experience in clinical, administrative and academic healthcare. He is currently an associate professor for Rocky Mountain University of Health Professionals doctoral program in health promotion and wellness. Dr. Nauert began his career as a clinical physical therapist and served as a regional manager for a publicly traded multidisciplinary rehabilitation agency for 12 years. He has masters degrees in health-fitness management and healthcare administration and a doctoral degree from The University of Texas at Austin focused on health care informatics, health administration, health education and health policy. His research efforts included the area of telehealth with a specialty in disease management.